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Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, P.R. China
Correspondence: Address to Dong-Lai Ma, MD, Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China.
Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, P.R. China
An otherwise healthy 30-year-old man presented with oyster shell-like skin lesions (Figure 1) on his scalp, face, trunk, arms, and legs of 1 month’s duration. He denied excessive alcohol ingestion or drug use. Three months ago, he had a high-risk sexual exposure. Physical examination revealed condylomata lata (Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org) in the perineal and perianal areas. Skin biopsy revealed a dense infiltrate of lymphocytes, plasma cells, and neutrophils in the dermis. The presentation of condylomata lata and marked plasma-cell infiltration on histological examination raised the possibility of secondary syphilis. Warthin-starry stain demonstrated the presence of syphilis spirochetes (Figure 2). Rapid plasma reagin (RPR) titres were 1:32, and treponema pallidum hemagglutination (TPHA) was reactive. A diagnosis of rupioid secondary syphilis was made. Human immunodeficiency virus (HIV) serology results were negative. The patient was treated with 3 doses of benzathine penicillin G (2.4 million units per week) with rapid resolution of cutaneous lesions within 3 weeks without scarring (Supplemental Figure 2). Repeat RPR titer decreased to 1:8 after 6 months.
Figure 1Multiple erythematous plaques with conical, oyster shell-like, dirty-appearing, hyperkeratotic crusts on the scalp and face.
Rupioid syphilis classically affects those with compromised immune conditions, such as malnourishment and alcoholism; injection users, HIV carriers, and patients with AIDS are also at risk.
In rare cases, it can also appear in immunocompetent patients, as in our case. Attention should be paid to prevent secondary infection when examining skin lesions. First-choice treatment is 3 consecutive weekly intramuscular injections of benzathine penicillin. Intravenous penicillin G for 14 to 21 days needs to be considered if the patient is HIV-coinfected.
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